OP0159 INCREASE RISK FOR CORONARY ARTERY DISEASE AND MYOCARDIAL INFARCTION IN SCLERODERMA-A NATIONAL INPATIENT SAMPLE ANALYSIS
Authors: K. Raj, V. Jyoti, M. Marte Furment, B. Ann Joseph, K. Jyotheeswara Pillai
Journal: Annals of the Rheumatic Diseases (2022)

Background Several rheumatologic diseases such as SLE and Rheumatoid arthritis are well known to increase cardiovascular risk. Scleroderma is well known to cause microvascular dysfunction, which can cause microvascular Coronary artery disease (CAD). However, Scleroderma is not classically associated with macrovascular CAD. Objectives We wanted to study the association of both microvascular and macrovascular CAD and Myocardial infarction (MI) in Scleroderma patients using the NIS (National inpatient sample) of the United States (US). Methods We included adult patients admitted to teaching hospitals with a primary or secondary diagnosis of Scleroderma from the National inpatient sample (NIS) of 2016, 2017, and 2018. The NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays. After coding for the relevant variables based on the ICD-10 coding system, we performed univariate and multivariate logistic regression analysis to determine if Scleroderma was associated with CAD and MI. As there was no ICD-10 code for macrovascular CAD, we used Percutaneous intervention (PCI) and Coronary artery bypass grafting (CABG) to indicate the presence of macrovascular CAD. Four separate models with outcomes as CAD, MI, PCI, and CABG were created. Results A total of weighted 57,739 (95% CI 55,787-59,692) hospitalizations with Scleroderma were included. Only 0.1% of CAD and MI patients had a history of Scleroderma. On univariate logistic regression, Scleroderma was not associated with an increased risk of CAD (OR 0.82, 95% CI 0.79-0.86, P&lt;0.01). After adjusting for age, sex, race, family history of CAD, dyslipidemia, diabetes, hypertension, and smoking, Scleroderma was associated with CAD (OR 1.40, 95% CI 1.34-1.47, P&lt;0.01) (Table 1) and MI (OR 1.13, 95% CI 1.02-1.25, P=0.01) but not with PCI (OR 0.86, 95% CI 0.73-1.01, P=0.07) or CABG (OR 0.79, 95% CI 0.61-1.03, P=0.09). Conclusion CAD in Scleroderma is due to the combined effect of Scleroderma itself and co-existing cardiovascular risk factors. In our large epidemiological study, Scleroderma was associated with CAD and MI despite adjusting for the traditional risk factors for CAD, which is consistent with our current understanding of Scleroderma. Scleroderma is suspected of causing recurrent coronary microvascular inflammation and ischemia, which leads to ischemic necrosis and myocardial fibrosis (1). Other mechanisms include coronary Raynaud phenomenon and myocarditis. The lack of association of PCI and CABG with Scleroderma likely suggests that CAD in Scleroderma is mostly microvascular. Potential limitations of our study are its retrospective nature and the lack of catheterization data. Cardiovascular diseases account for 12% of mortality, and CAD accounts for 5% mortality in Scleroderma patients (2). Therefore, care for Scleroderma patients should involve aggressive management of Scleroderma and the risk factors for CAD. Table 1. Multivariate logistic regression model for CAD References [1]Faccini A, et al. Coronary microvascular dysfunction in asymptomatic patients affected by systemic sclerosis - limited vs. diffuse form. doi: 10.1253/circj.CJ-14-1114. [2]Tyndall AJ, et al, Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. doi: 10.1136/ard.2009.114264. Disclosure of Interests None declared